Cervical Spondylosis (Nutshell) with pictures

This presentation throws light on Cervical Spondylosis (neck pain) in brief.
It includes information regarding causes, pathophysiology, diagnosis and treatment of cervical radiculopathy.
this ppt is very easy to understand and has good exam material for mbbs, homeopathy and ayurveda students.
it contains lot of pictures for better understanding of the topic.
humans have fallen prey to machines. In the name of technology we have compromised our health and well being due to lack of physical activity and continuous use of mobile phones, laptops and computers. this ppt will teach you how to stay away from those morbidities and prevent your cervical spine damage in the long run.

1. Cervical Spondylosis Dr Aakash Nandu M.S. Orthopaedics Smit Hospital, Anand

2. Cervical Spondylosis Definition It is chronic degenerative disorder of cervical spine which affects vertebrae, inter vertebral discs and ligaments of cervical spine. Anatomy Cervical spine consists of 7 vertebrae beginning from the base of the skull. There are 8 pairs of nerve roots exiting posteriorly from spinal cord through foramen in between the vertebrae.

3. Introduction Commonly seen in individuals after the age of 40 years Believed to be a part of normal ageing process of vertebral column. Includes degenerative changes in facet joints, longitudinal ligaments and ligamentum flavum.

4. 2 main components Spinal canal stenosis leading to MYELOPATHY Lateral canal stenosis leading to RADICULOPATHY.

5. Morbidity ranges from Chronic neck pain Radicular pain Diminished cervical ROM Suboccipital headache Myelopathy leading to weakness and impaired fine motor functions, incoordination, quadriparesis, sphincter dysfunction, etc The course of cervical spondylopathy may be slow and prolonged, may either remain asymptomatic or have mild cervical pain.

6. Pathophysiology IVD loses hydration with age Loss of elasticity Cracks and fissures in annulus fibrosus Nucleus pulposus bulges out Cross sectional area of Spinal Canal is narrowed

7. Facet joint and ligamentum flavum hypertrophy occurs Decreases the dorso -lateral space of the foramen Contributes to radiculopathy Marginal osteophytes develop and end plate destruction occurs.

8. Clinical features 1. Cervical Pain Chronic suboccipital headache May radiate to shoulder, scapula or arm Pain increases with certain movements 2. Radiculopathy Compression of cervical roots leads to radicular pain or muscle weakness Mostly resolves with conservative management, rarely surgery is required.

9. 3. CSM (Cervical Spondylotic Myelopathy) Most serious consequence of CS Occurs due to narrowed vertebral canal Quadriparesis, sphinchter involvement occurs Complete reversal is rare once CSM occurs

10. Etiology Age (>40) Trauma Work activity (carrying load on head) Genetics

11. Physical examination Decreased ROM Hand clumsiness Sensory Deficits Exaggerated reflexes or absent reflexes Spastic gait Extensor plantar reflex in severe myelopathy

12. Spurling sign – exacerbation of radicular pain by lateral flexion towards affected side (due to foraminal narrowing) Lhermitte sign – generalized electric shock like sensation due to neck flexion Hoffman sign – reflex contraction of thumb and index finger in response to nipping of middle finger ( sign of UMN lesion )

13. Diagnosis 1. Clinical 2. Xray 3. MRI

14. Treatment 1. Immobilisation Reduces irritation of nerves Daytime soft cervical collar More rigid orthosis (Philadelphia collar, minerva jacket) 2. Moulded Pillows For better alignment of spine during sleep

15. 3. Exercises Isotonic isometric cervical spine exercises to maintain the strength of neck muscles 4 Heat therapy Superficial – moist heat packs Deep – Diathermy, local US 5 Manual or Mechanical traction foraminal widening leads to pain relief

16. 6 Occupational therapy Ergonomic adjustment of workplace, postural correction and vocational therapy. 7 Pharmacological NSAIDS Opioids Pregabalin, Nortryptiline

17. Surgery Indications Progressive neurological deficit Intractable pain Documented compression of nerve root or spinal cord

18. Types of surgeries Discectomy Decompressive laminectomy and foraminotomy Hemilaminectomy Laminoplasty